In the well-known words of Winston Churchill, "You can always count on Americans to do the right thing--after they've tried everything else."
When it comes to health care, however, we can only hope that America's lawmakers will live up to Mr. Churchill's modest expectations. After trying for seven years to craft a bill that would repeal and replace the Affordable Care Act (and after trying for seven months to pass one), Republicans in Congress continue to face widespread resistance against any plan that might cause millions of people to lose their insurance.
At the same time, critics are right to point out that the ACA has real flaws--even the bill's supporters can admit that in too many places, the ACA's health-care marketplaces are in dire need of more competition and lower prices. Premiums continue to rise, as do health-care costs overall. And while the ACA has helped over 20 million more Americans access health coverage, tens of millions remain uninsured.
These problems are not unsolvable. Compared to the United States, nearly every other developed country provides better health-care outcomes for less cost. The time has come for leaders from both parties to shift from arguing over the language of "repeal" or "repair" to a willingness to regroup and rethink, from scoring political victories to doing the right thing for their constituents.
To seize this opportunity, however, legislators will have to approach the challenge of crafting health-care legislation far differently than they have in the recent past.
Rather than dictating priorities from the Capitol, Washington must start by listening to the states. For governors and local lawmakers, health care is not an ideological abstraction or political prize. Health care is one of the most sensitive, important parts of their neighbors' lives. And because state budget rules are far more restrictive than federal ones, governors cannot simply throw money at a problem.
It is no surprise, then, that governors and state legislatures across the country have found innovative, bipartisan ways to expand coverage and control the cost of care. Take what happened in our shared home state of Arkansas. Even before the Affordable Care Act we understood that we had to confront the challenge of runaway cost increases. Specifically, we had to do something about a fee-for-service system, one where doctors were paid for doing more, rather than creating better outcomes.
Changing such an entrenched arrangement was not easy, and our state's work is far from finished. But in less than a decade, we've made remarkable progress. We brought public and private-sector insurers together around a common set of goals, providing clarity and certainty to hospitals, doctors, and patients alike. We shifted incentives for health-care providers: if an Arkansas hospital can reduce costs while maintaining quality of care, we split the savings 50-50. And we used ACA funds to create a program that covers as many (perhaps even more) people than Medicaid expansion would have, but is run entirely by the private sector.
For nearly all these years, Arkansas had a Democrat in the statehouse and a Republican majority in the Legislature. Yet we found ways to put our citizens' needs above politics, with undeniable results. Competition in our ACA marketplace has grown from one statewide carrier to three statewide carriers. Last year, we had lower premium increases than all but two states. We have the lowest premium for family policies of any state.
Success stories like Arkansas' demonstrate that the way forward on health care cannot be decided solely by Washington. Instead, senators and representatives must begin by asking governors about their constituents' needs, and by providing them the flexibility to come up with innovative solutions for their states.
Just as lawmakers must rethink their Washington-first approach to health care, they must also abandon the extreme go-it-alone partisanship that has characterized the most recent efforts at Obamacare repeal.
There is a decades-long precedent of both parties coming together to shore up a major law--even an initially controversial one--in the years after it passes. Social Security and Medicare, for example, were opposed at first by large numbers of Republicans. Medicare Part D was opposed by large numbers of Democrats. Yet in all three cases, Congress recognized that the American people would be better served by improving the law in question rather than re-litigating settled debates.
It is time for lawmakers to apply that same willingness to put country before party to the Affordable Care Act. Out of sight of the TV cameras, and when not directly addressing their respective bases, most Democrats will agree that the ACA is far from perfect. Most Republicans will agree that there are fixes that align with conservative principles and would pass the Senate with 70 or more votes.
In fact, many legislators have already begun proposing common-sense improvements to our health-care system. Senators Tim Kaine and Tom Carper have proposed establishing a federal re-insurance program, one similar to a state program in Alaska that has already been shown to reduce premiums. Senator Dianne Feinstein has introduced a bill to end the ACA's "subsidy cliff," instead capping spending on health care premiums at 9.66 percent of a person's income. A bill written by Senator Claire McCaskill would allow people living in a county where no health-care plans are offered on an ACA exchange to buy plans from the Washington, D.C. exchange instead.
Nor are these improvements being proposed by solely Democrats. Senators Chuck Grassley, Amy Klobuchar, Mike Lee, and Patrick Leahy have co-authored a bill that would bring down prescription drug costs by increasing competition in the pharmaceutical industry.
Such a bipartisan effort is commendable, and perhaps an encouraging sign of things to come. At countless times in our nation's history, lawmakers have forged unlikely alliances on behalf of the men and women they serve. There is no reason this kind of cooperation cannot occur today. And if it does, we can improve patients' lives, save money, and provide market stability to businesses that sorely need it.
Strengthening our health-care system will not be easy. In today's Washington, common ground appears more elusive than ever. All of us, including the president, agree that health care is complicated. But the right approach on health care is deceptively simple. By listening to the states, and by working across the aisle on common-sense improvements to existing law, we can do right by our people, and demonstrate the best of America to the world.
Mike Beebe was the 45th governor of Arkansas. Mack McLarty was the chief of staff to President Bill Clinton and is now the chairman of McLarty Companies and McLarty Associates.
Editorial on 07/27/2017